Provider Demographics
NPI:1154032365
Name:WINGLER, KERI MARIE (RN)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:MARIE
Last Name:WINGLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 JENWILL DR
Mailing Address - Street 2:
Mailing Address - City:PURLEAR
Mailing Address - State:NC
Mailing Address - Zip Code:28665-8901
Mailing Address - Country:US
Mailing Address - Phone:336-469-5517
Mailing Address - Fax:
Practice Address - Street 1:CORNER OF ROUTE 7 AND ROUTE 12
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC292148163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency